title: Surgeon's volume is not associated with complication outcome after laparoscopic cholecystectomy.
abstract: OBJECTIVE
  Complication rates after laparoscopic cholecystectomy vary but are still reported to be up to 17 %. Identifying risk factors for an adverse complication outcome could help to reduce morbidity after laparoscopic cholecystectomy. Our aim was to analyze whether surgeon volume is a vital issue for complication outcome.
  
  
  METHODS
  All complications-minor, major, local and general-were reviewed in a single institution between January 2004 and December 2008 and recorded in a database. Patient's variables, disease related variables and surgeon's variables were noted. The role of surgeon's individual volume per year was analyzed. A stepwise logistic regression model was used.
  
  
  RESULTS
  A total of 942 patients were analyzed, among which 70 (7 %) patients with acute cholecystitis and 52 (6 %) patients with delayed surgery for acute cholecystitis. Preoperative endoscopic retrograde cholangiography (ERC) had been performed in 142 (15 %) patients. Complication rates did not differ significantly for surgeon's individual volume (≤10 vs. >10 LC/year, 5.2 vs. 8.2 %, p = 0.203) nor for specialization (laparoscopic vs. non-laparoscopic; 9.2 vs. 6.4 %, p = 0.085) and experience (specialty registration ≤5 vs. >5 years; 5.1 vs. 8.7 %, p = 0.069). The only significant predictors for complications were acute surgery (OR 3.9, 95 % CI 1.8-8.7, p = 0.001) and a history preceding laparoscopic cholecystectomy (LC) (ERC and delayed surgery for cholecystitis) (OR 8.1, 95 % CI 4.5-14.6: p <0.001).
  
  
  CONCLUSIONS
  Complications after LC were not significantly associated with a surgeon's individual volume, but most prominently determined by the type of biliary disease.
authors.affiliation: Department of Surgery, Onze Lieve Vrouwe Gasthuis (OLVG), Postbus 95500, 1090 HM, Amsterdam, The Netherlands, donkpas@online.nl.
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Donkervoort
authors.forename: Lea M
authors.initials: LM
authors.lastname: Dijksman
authors.forename: Pieter G
authors.initials: PG
authors.lastname: Versluis
authors.forename: Emile A
authors.initials: EA
authors.lastname: Clous
authors.forename: Anco C
authors.initials: AC
authors.lastname: Vahl
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies